Why nostril stenosis develops after alar reduction and philtrum reduction, and how to reconstruct it

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a case of nostril stenosis reconstruction following multiple nasal surgeries, alar reduction, and philtrum reduction.

1. Front view

- Blunt and broad nasal tip

- Nostril asymmetry

- Pinched nasal tip

- Deviated nasal bridge

2. Nostril view

- Nostril asymmetry

- Columella deviated toward the left

- Left nostril stenosis

- Scar tissue inside the left nostril

1. Septal reconstruction and septal extension using autologous rib cartilage

2. Crooked nose correction via lateral osteotomy

3. Rotational flap for correcting nostril stenosis

4. Alar cartilage reconstruction

5. Removal of intranasal scar tissue

6. Nasolabial angle correction

1. Severe damage to the septal and alar cartilages from previous surgeries

-> Restored through septal and alar cartilage reconstruction using autologous rib cartilage

2. Abundant scar tissue in the nasal tip partially excised

3. Severe left external nasal valve (nostril) stenosis

-> Partially excised scar tissue and widened the nostril using an intranasal skin rotational flap

1. Frontal view improvement

2. Profile view improvement

- Increased tip projection to correct the flattened look and add three-dimensional definition

- Set the radix moderately low, around the level of the pupils

- Created an overall feminine line that does not look overly long

3. Oblique view improvement

- Achieved a far more refined profile compared to before surgery

- The nasolabial angle was corrected, improving the appearance of a protruding mouth.

4. Nostril view improvement

- Improved the nasal tip deviation to the left caused by left nostril stenosis

- The reduced size of the left nostril from the prior alar reduction remained an anatomical limitation

- Improved symmetry between both nostrils, and resolved nostril stenosis by cleanly removing internal scar tissue

Comparing the preoperative nostril view with the stage after removing internal scar tissue and prior to alar reconstruction shows noticeable improvement; to achieve a better outcome, an additional procedure was simultaneously performed to widen the left ala laterally.

In the photos taken on day 0 immediately after surgery, you can observe a much more natural and refined impression compared to before surgery, with marked improvement in nostril stenosis. Immediate postoperative photos show swelling and may differ from the final result.

When performing revision rhinoplasty frequently, the most regrettable situations are when previous over-resection during alar reduction limits what can be achieved. In particular, excessive excision of the alar tissues can leave nostrils overly constricted, creating both cosmetic dissatisfaction and functional nasal obstruction. Nasal obstruction due to external nasal valve (nostril) stenosis is notoriously difficult to correct. What makes this surgery particularly challenging is that improper intervention can actually worsen the stenosis, requiring a meticulous, gentle, and highly precise approach.

Above all, procedures involving the alae that can reduce nostril size—such as alar reduction or philtrum reduction—must be approached with extreme caution and kept to a minimum. Furthermore, if complications arise after alar reduction, patients should thoroughly consult an experienced specialist before deciding on further excision.

Today, I shared a case of reconstructing nostril stenosis caused by aggressive alar reduction.

I hope this proves helpful to those experiencing similar concerns.

This was Dr. Peter C. Kang. Thank you.

Thank you.

#closedrhinoplasty #closedrevisionrhinoplasty #complexclosedrevisionrhinoplasty #nostrilstenosis #alarreconstruction